Having a good vet is essential to your cat's chances of
Ideally you want a knowledgeable, caring vet with whom
you can work in partnership to give your cat the best care possible.
This page has tips on deciding whether your vet is the
best vet to help you on your CKD journey, how to work together as a team, how to find another vet if
you decide to move, and how to get a second opinion.
It also discusses the importance of recordkeeping.
If you want to be able to give your cat the
best possible treatment, you need a good vet. Whilst not the only factor
(it also depends upon your particular cat, how sick s/he is at diagnosis,
how much s/he wants to fight, how well s/he copes with being handled
etc.), a good vet can make all the
difference to your cat's quality of life and chances of survival, whereas
if you have to fight your vet for treatments, it is reducing your cat's
chances of survival, not to mention using up your time and
energy and stressing you out. This is not only my opinion: In
Renal disease (2006) Dr D Polzin
says "With appropriate therapy, cats with stages 2 and 3 CKD commonly
survive 1 to 3 years...however, many survive much longer. A host of
factors influence prognosis of CKD, both favorably and unfavorably.
Included among these factors are the quality of medical care provided to
the patient, the degree of interaction between the veterinarian and pet
owner, and the level of owner commitment."
I do not wish to disparage vets, who work very hard to qualify, and most
of whom genuinely love animals; but as in every other profession, some
vets are good, others not so good, and a small percentage very poor. Thus
it is essential that you can recognise a bad vet - your cat's life depends
upon finding a good one.
You need a vet with whom you can work in partnership. You do not have to
like your vet, but you have to be able to communicate and work together.
your vet has superb diagnostic and caring skills, if your personalities clash,
or if you too intimidated to ask questions, you
are not a good match.
It can be hard enough finding a vet you trust and respect, but finding one
who is also skilled at managing CKD is an additional challenge. This does
not mean your vet is incompetent. Most general vets will be good at what they deal
with most of the time. Typically, they will be seeing primarily dogs and cats,
who in the main are young, usually healthy animals,
for vaccinations, neutering, the occasional infection and perhaps teeth cleaning
every now and then. Vets deal with multiple species and run busy practices
(every vet I know works very long hours), and cannot possibly be expected
to keep up with the latest research for every ailment in every species.
For this reason, it is not necessarily a dealbreaker if your vet is not up
to speed on CKD, because as a general vet s/he simply does not have the
time. What is more important is that your vet is willing to
learn and is open to new information. This is where you come in. You are your
cat's advocate. You know your cat best, and you can research treatments
that might be suitable, ready to discuss them with your vet. This site
will help you with that.
Your goal therefore is to find a vet who accepts that you are a
partnership. Good vets are prepared to listen, to answer all your questions,
to explain all
the options available to you (not just the ones they favour), including
the risks and benefits of those options, and to admit they don't know everything.
They should be prepared to read selected research papers you bring in
it is unreasonable to expect your vet to read a 20 page research study
overnight!). They should also accept that old age is neither a disease nor a
In turn, you have to listen to your vet, who has medical training which
you do not have, so you may have got the wrong end of the stick. You
should be on time for appointments, pay your bills promptly (or according
to an agreed payment schedule), inform your vet of every treatment you are
using (some people think their vet doesn't need to know about holistic
treatments, but they do) and basically try to be the kind of
client you would like to have yourself.
Make it clear to your vet
that you will listen to his/her advice, but that you also want your own
views taken into account. You see your cat every day, your vet does not.
Perhaps offer to make
a deal regarding when you would consider letting go (see
The Final Hours for more information on quality of life
This is particularly common in the UK, especially for people who are
trying to find a vet who will allow them to give sub-Qs to their cat, but people in other countries may
also have problems.
If your vet is not helpful, you need to find out why this is the case.
There are two main reasons why some vets may seem to be less than helpful.
The first is that they think it is unfair on the cat, usually because they
think there is no hope so any treatment is pointless (though in the UK,
people also have trouble obtaining sub-Qs because the vet thinks they are
You do need to respect your vet's knowledge and experience, and accept
that it might well be true that your cat's case is hopeless. At the same
time, most people also need to know they have done all they can. Treatment
may not help, but not trying to treat certainly won't.
As one member of
Tanya's CKD Support Group
put it, what adversely affects her cat's quality of life is denial of
treatment. The current situation is like a snapshot in time, especially if
your cat has an infection, high blood pressure or is dehydrated, and
things may change dramatically with appropriate treatment.
No vet has a crystal ball.
Contrary to popular opinion, medicine is not black
and white, there are many shades of grey, and different vets will have
varying knowledge and experience which will mean they may have different
opinions, sometimes even within the same practice. So your vet's opinion
is just that, an opinion, albeit a professional one.
The second factor in a vet's approach is client expectations. Upon
receiving the CKD diagnosis, many people simply assume that things are
dire and the end is nigh, especially if the vet uses the term "renal
failure." Even if they knew of the treatment options
described on this site, they would not be willing to try them or think
their cat would not tolerate them, or they (or the vet) think they cannot
afford them. Since most people take this approach, your vet may assume it
is also your approach unless you make it absolutely clear that this is not
Thus, the first thing you need to do is make it clear to your vet that you
wish to fight for your cat and be proactive. You also need to discuss your
financial limitations, though if your vet is prepared to write you a
prescription, you can often buy basic supplies cheaply online. If your vet
doesn't know you very well, perhaps because your cat has always been very healthy
up to now, you will also need to win your vet's trust.
If your vet is still not helpful or hopeful, discuss the situation and see
if you can nevertheless find a way to work together. In 2012 the Royal
College of Veterinary Surgeons (to which all vets practising in the UK
must belong) issued a revised
Professional Code of Conduct for Veterinary Surgeons
which states "veterinary surgeons and veterinary nurses must accept that
their own preference for a certain course of action cannot override the
client's specific wishes, other than on exceptional welfare grounds." If
you are in the UK, you could politely point this out and ask for your
wishes to be respected.
It can be hard to do this, especially if you're not a
particularly confident person who finds it hard to negotiate.
If you ask for a treatment with which your vet is not familiar, you are
taking the vet out of his/her comfort zone, especially if you utter the dreaded
words "I read it on the internet." Make it easier by providing supporting
documentation (I'm not a vet, so use veterinary references which I link to
support what I say rather than my site itself if possible), and ask them to help you understand it. Perhaps offer to
fax it over and give your vet time to digest it; this can mean less
pressure for both parties than talking face to face. Remember, negotiating
is not about winning. It's about reaching an arrangement that both parties
are reasonably happy with. Asking to treat for two weeks before making a
decision to euthanise is a reasonable compromise that many vets can
accept. Also see
Subcutaneous Fluids - Winning Your Vet's Support
for tips on this issue in particular and how to win your vet over
If your vet still won't help, you will need to either get a second opinion,
which may help persuade your vet to work with you, or find a new vet. See
below for suggestions on how to do this.
How to speak for Spot by Dr Nancy Kay is
about how to decide which treatments would be the best choice for your dog
in your particular circumstances but the principles apply to cats too.
If your cat is in crisis and you simply want to find somebody who is
willing to give your cat a chance, you may not have much time to shop around.
If you are in the UK in particular, just finding a vet who permits
sub-Qs is a bonus, and you may be prepared to move on that basis alone.
If you do have the luxury of picking and choosing, below are some of the
factors you may wish to consider. This is how I would go about obtaining
the information I require:
The first thing I would do is check the practice website to get a feel
for the way it is run and to see if one of the vets catches your eye.
You can then call and speak to the receptionist or practice manager to
find out basics such as cost or length of routine appointments.
If it seems promising, ask to speak to a vet or a vet nurse/tech with
your more technical questions. Ask for just five minutes of their time,
with them calling you back at a time convenient to them if necessary,
and try not to exceed the time limit.
If you like the sound of the practice, consider making a paid for
appointment to see the vet where you can discuss your cat's case and
check out the facilities. You may not even need to pay for your first
visit - some US chains (e.g. VCA, Banfield) often give you the first
appointment free. Not everyone takes their cat to this appointment, but
I figure if I'm going to see the vet anyway, it is helpful to see how
the vet handles my cat.
If you ever have to rush your cat to the vet in an emergency, time can
be of the essence. Even for non-emergencies, it is less stressful for
both you and your cat to have a vet nearby. However, it is better to
travel to a more competent vet than to make do with a less competent one
Mobile vets can be a good choice to reduce stress. As a bonus, they may
see more elderly animals and therefore be relatively experienced at
You need to know both the practice hours and the vet's own hours. Some
vets will only be at a practice for a day or two a week, which is not
ideal if you want continuing care. If your vet is not there fulltime
(and even if s/he is), ask to meet another vet at the practice so you
have back up available in case of need.
One very important question with a CKD cat is whether you can be seen on
the same day if your cat requires it. I would never use a vet who did
not do this.
If you are in the UK, vets are obliged to provide 24/7 cover, but this
will not necessarily be from your own vet's practice, so ask about that.
If you are in the USA, you will often have to travel to an ER facility
for out of hours cover, so clarify which facility your vet uses.
This matters to most of us, but ideally it should not be the defining factor.
Ask how much a consultation costs, and how much standard blood tests and
blood pressure checks cost. Do they charge for every little thing, or
might they give you smaller items for free, such as a syringe for assist
feeding. Also check hospitalisation costs - if your cat ever needs
intravenous fluids, you don't want to get a nasty shock when you get the
Can they provide CKD supplies at reasonable cost? If not, do they charge
to write a prescription? This is now legal in the UK. If they do, ask if
they make prescriptions valid for a year.
Ascertain how long appointments last. One of my vets allocated 30
minutes to each appointment, which is obviously good. Strangely enough,
he didn't charge more than other local vets whose appointments only
lasted 10-20 mins.
Facilities and Testing
My ideal is a cat-only practice, but I've never found one that worked
for me. Clarify how easy it is to park and whether it is free. Ensure
the waiting room is clean and ideally with a cats only waiting area.
Watch how the vet handles your cat. Ask if you can be present for basic
testing. Vets do not always agree to this because there are potential
liability issues if you get bitten or scratched by your own cat, even if
you ask to stay, but my vet trusts me not to sue her in such
circumstances. I always ask to be present for blood pressure testing in
particular, because being away from me can increase my cat's blood
pressure. Make sure they do not sedate all cats routinely for blood draws.
Although some people care about punctuality, and this may matter if you
have to get to work, it's not something that I stress over too much,
because I figure that if the vet keeps me waiting because of another
client, I also won't be rushed should my cat need longer on occasion.
What I do care about is that my vets share test results with me
promptly. My vets ring me the same day that they receive specialised
test results back, and have done so at 10 p.m. on occasion when
something has been faxed over late at night and they know I will be
It is worth asking how often the vet treats CKD cats and what is the usual
treatment protocol. It is encouraging if the vet has experience treating
CKD cats over a period of years, and can deal with complications such as
anaemia, but a less experienced, open-minded vet is not a problem for me.
You also need to know how much experience your vet has in other areas,
e.g. can basic surgery be performed in house, who do they use if a cat's
needs are outside their area of expertise or if they or you require
additional help or a second opinion.
Remember, you cannot get everything you like in one vet, so decide what
matters most to you. For me, having a vet who I trust who listens to my
suggestions and who can see my cat quickly in an emergency is more
important than the fact that she charges to write me a prescription
(though I still wish she didn't!).
Finally - it helps, but is not essential, if your vet likes cats.
Special Needs Pets has useful information on choosing a vet,
and on working together with him or her.
If you live in a small town, you probably don't have much choice of
vets. If you live in a large city or near a vet school,, you have more
choices available to you.
In the UK, you will usually need a referral to a specialist from your
main vet, but this is not always necessary in the USA.
Most of us end
up using a general vet. This is not necessarily a bad thing. Although I
used an ACVIM (see below) diplomate vet in the USA who was excellent, my UK vet is a general vet in the small town
where I live, and she is great.
If you're using a general vet, you can at least try to find one who is
interested in feline health. In the USA, The
American Association of Feline Practitioners lets you search for a vet
in your part of the USA. These vets don't necessarily have specialist
training, but they like treating cats, which is encouraging. If you use an
AAFP practice, you can also point out that the AAFP recommends this
Specialist Vets in the USA
You may wish to use a vet who is an internal medicine specialist. I used
such a vet in the USA. These
vets have additional training, which can be very helpful when dealing
The American College of
Veterinary Internal Medicine (ACVIM)
has a list of its diplomates, who have undergone an additional three
years specialist training. Search for a specialist in Small Animal
Cat Professional is run by Dr Sarah
Caney, a feline specialist. She offers e-mail advice to vets and will do
telephone consultations with cat owners who are referred to her by their
own vet. There is a fee for this service. She also runs
in Edinburgh which cost
£72 if paid for in advance
(tests are extra).
I maintain a private list of British vets who permit sub-Qs when
appropriate. Most of them are not specialists, but they are open-minded
about sub-Qs. If you are in the UK and need such a vet, please read
here about how to
obtain details of any vets in your area, though unfortunately the list
is very short, so the chances of such a vet being in your area are sadly
If you are concerned about your vet's approach, you may wish to seek a
second opinion. Vet schools are a good choice if there is one in your
area. In the UK, if you ask for a second opinion, your vet should be
happy to refer you, but it is not always easy finding a specialist to
consult, though see specialist vets above for some options.
Here are some options if there is no specialist near you.
Cornell Feline Consultation Service
Cornell University College of Veterinary Medicine
Dr Louis J Camuti Memorial Feline Consultation Service is a
possible alternative, no matter where you are in the world, as long as
you or your vet can speak English. This service offers
advice on feline health related issues. You need to provide as much
information as possible (e.g. blood test results), then the consultant
will contact you or your vet to discuss your cat's situation, usually
within 48 hours but occasionally it takes a bit longer. The service costs US$55 and is
available Mondays, Wednesdays, and Fridays, 9 a.m. - 12 p.m. and 2 p.m.
- 4p.m. Eastern time (not holidays). If you are calling from outside the
USA, you may have to pay for the cost of the call back from the
Cornell has an excellent
reputation, and I have heard from several people who have used this
service, and virtually all of them were very satisfied.
The Veterinary Information Network
offers assistance from 250 veterinary specialists, including four
nephrology consultants, to its members. Your vet can join for US$58 a
month, but a 30 day free trial is also available.
It is a good
idea to keep your own records, so you can monitor trends and have
information readily available should you decide to move (either town or
vet). It is particularly important if you are in the USA, because
most people in the USA have to go to the ER if their cat is sick out of
hours, and it is very helpful to the ER staff if you can provide them
your vet is, I strongly recommend keeping your own records of your cat's
symptoms and behaviour on a daily basis, together with bloodwork results
and which treatments you tried. This can help you to monitor trends, and
can also serve as a reminder of what treatments worked should a symptom
recur some months later.
Be very sure to
keep records of allergies, particularly to drugs, and make sure these are
clearly marked on your cat's notes.
Some practices are strangely reluctant to share records. I think some of
them worry that a little knowledge can be a dangerous thing (and they
are right in some cases). I've also been told in the past by a vet nurse
that there was no point giving me my cat's records because "you won't
understand them." I must admit, that gave me a bit of a giggle. In
fairness to the vet nurse, she didn't know I run this site, and what she
said is probably true of most of their clients; but we can all learn
what the tests mean.
From what I hear, if you ask the receptionist for your records, you will
often be refused. If this happens, ask the vet directly, who will
probably agree, especially if you are in the USA and need to visit an ER
vet if your cat requires urgent help when your vet's office is closed.
If you continue to have trouble obtaining copies of your records,
especially in cases where the clinic says the records belong to them, it
may indicate that this practice is not going to be too good at treating you
as a partner in your cat's care.
RCVS Guide to Professional Conduct
requires (Clauses 13.5 and 13.6) that vets must give owners records and test results when
asked to do so, although they can charge for doing so.